ALBANY — Anxiety, conduct disorder, ADHD, depression, substance abuse, trauma, physical and sexual abuse, and cyberbullying are among the issues young people face that impact their mental health. Often, the children and their parents may not know where to turn.
Anger, aggression, hopelessness, fatigue, fidgeting, irritability, loss of appetite, mood swings, restlessness, cutting, paranoia, changes in weight and isolation may be among the responses parents see in their children. The National Alliance on Mental Illness, or NAMI, says that 50 percent of all chronic illness begins before age 14, and 75 percent begin by age 24, with 20 percent of all youths ages 13-18 living with a mental health condition.
Lisa Spears, child and adolescent coordinator and therapist at Aspire Behavioral Health and Developmental Disability Services, is based at Aspire’s clubhouse on Dawson Road. The after-school facility serves 136 students who have some kind of mental health diagnosis. While offering counseling for children, Aspire works with emerging adults to help them transition and conducts school-based individual and family therapy on 13 campuses in Dougherty, Lee, Worth and Early counties.
Aspire also provides community services related to suicide prevention, and works with individuals between ages 16-30 who have had their first psychotic break.
“One in four children has a mental health diagnosis,” Spears said. “That is huge, and those are the children on the radar.”
Spears said suicide attempts are taking place at a younger age, as pressure on children has intensified due to social media and the urge to live at a faster pace.
“(Social media and bullying) have always been hot topics, but we are seeing more of it now,” she said.
She said ADHD, bipolar, anxiety and depression are the top diagnoses Aspire sees among children.
In December, Gov. Nathan Deal announced the release of a report from the Commission on Children’s Mental Health, a commission created via executive order in June to provide recommendations for improving state mental health services for children.
The report offered several recommendations that focus on critical areas of behavioral health needs, including suicide prevention, school-based mental health and telemedicine infrastructure. In creating the report, the commission received recommendations and feedback from around the state. Georgia’s Interagency Directors Team, a multi-agency group of child and adolescent experts established by the Behavioral Health Coordinating Council, was charged with facilitating an implementation plan based on the recommendations in the report.
Spears said she is encouraged by the commission’s existence and its recommendations, as it reflects a mindset that more resources need to be geared toward early intervention.
“The younger you can reach a child, the better the chances of recovery,” she said. “It is encouraging the need is being recognized. We want to get the information out into the community.”
Spears said partners have been brought in to increase awareness into southwest Georgia, particularly in rural communities where access to care is already limited.
“The biggest piece is understanding this is a priority at the state level,” she said.
The NAMI branch in Albany has literature on in-service presentations for school personnel to educate them on signs of mental illness in children, the “Ending the Silence” mental health awareness program for middle school and high school students, and an education program called “NAMI Basics” on Sunday afternoons for parents and caregivers of those with mental health challenges.
Jere Brands, program coordinator for NAMI Albany, said a youth initiative was started last year. Several training sessions have been held with community partners, including crisis intervention training for police officers.
“All the NAMI programs are free of charge,” Brands said. “Our training is free of charge. It is funded through the NAMI walks and (Georgia) Department of Behavioral Health.”
Brands said mental illness is considered a brain disease, with more damage likely to be caused during a crisis. She said people are talking about it more, but in general, the need for services has been stable in recent years — adding that research has shown that early intervention is the key to effective treatment.
“Mental illnesses are biological illnesses but can have (outside) triggers,” she said.
Brands said there are “very few” crisis centers for children in Georgia. Children have to go away from home to get treatment, and parents without reliable transportation may not be able to stay nearby.
Given that early intervention is critical, Brands said parents should act immediately when they see something wrong.
“They don’t have to have a firm diagnosis,” she said. “They just need to be concerned about the possibility.”
Lisa Schexnayder, manager at Phoebe Behavioral Health, and Jacqueline Childress, a therapist at the center, said the staff there provides therapy on an individual and group basis out of their offices at 500 W. Third Ave. with the help of child psychiatrist Dr. Mfon Inyang, the practice’s medical director. The center serves children with any mental health diagnosis and also conducts medication management.
“We don’t run a huge program here,” Schexnayder said. “We tend to run things on a smaller scale, which gives us more individualized care perspective to the patient.”
Experts admit that there are more obstacles in the home now than there once were.
“These days, you can’t parent like your parent used to parent,” she said.
The therapist said she would like to start a six-week summer camp, structured like a boot camp, so parents and teachers do not struggle with behavioral problems in the fall.
The adolescent group at the center currently meets on Wednesdays for two hours, while the children’s group meets on Tuesdays and Thursdays for two hours.
“It allows us to assess on a weekly basis,” Schexnayder said, “The most we have is eight people; we have an average of five.”
Childress said smaller groups allow her to get to know the children. A dangerous trend she has noticed is that medication, while needed in some cases, is overutilized — and the tendency when there are emotional challenges is to go straight to anger.
“Pills are only one part of the whole equation,” Schexnayder said. “(Childress) and Dr. Inyang work very closely together. We have a good rapport with schools and DFCS (Department of Family and Children Services). We have come a long way with the resources we have.”
Schexnayder said there has been a continuous need for mental health services for children. The need is not expected to go away, especially given what youngsters have to face in the world they live in.
“I would like to see more focus, personally, on the gay and lesbian community,” she said. “Parents need to understand it is out there.”
Childress said that it is often a forgotten fact that children can be as emotionally complex as adults, and that it might not be the best approach to encourage children to be seen rather than heard.
“We live in a time when children absolutely need to be heard,” she said. “What I get in my office is opposite of what parents get.”
Bullying especially can present a complex problem, because children are not built to ignore it. It has gotten meaner with the onset of social media, and sexting is becoming more common.
“We are trying to solve the problems in an old-school way,” Childress said.
Today’s youths are also growing up in a culture in which there is pressure to use drugs, and the issue of sex is coming up at a younger age than it once did. The suicide rate is also high, and parents now have to strongly consider restrictions on cellphone and social media use.
“Gone is the time you can assume ‘that kid’ is not your kid,” Childress said.
Childress said she is involved also with trauma-focused therapy, which Schexnayder said has been of particular benefit to DFCS children.
Mental illness is unique in that it is not visible. As disturbing trends evolve, there is greater motivation to protect the next generation when they encounter an obstacle they cannot understand.
“Just because you can’t see it doesn’t mean it is not there,” Schexnayder said.
Childress said southwest Georgia needs to do a better job of servicing its autism community. There is also a need for more specialized providers, play therapy and those trained to handle traumatic cases.
The need has become even greater as people in the field begin retiring.
“Not a lot of people are graduating and going into psychiatry,” Schexnayder said. “The percentage is even smaller for child psychiatry.”
Childress said many people think of the severe mental health case scenario, which is not the base. In the case of children, the tendency is often to think of them as small adults.
“We need to understand that they are different,” she said.
Like adults, however, youngsters can shut down emotionally when they are stressed by certain factors — such as body image. They may feel like their parents are not listening, and the parents may notice increased isolation, changes in social media habits, a greater tendency to give into anger or cutting.
The advice Phoebe gives is to ask open-ended questions in order to establish a line of communication.
“Try to communicate,” Schexnayder said. “If that is not working, call us.”
Dr. Rupert Dyer, pediatrician and internist with Albany Area Primary Health Care, said AAPHC has a counseling staff and nurse practitioners offering services for children as well as adults. He said children are just as prone as adults to mental health problems, yet they have even fewer options than their older counterparts.
“With an adolescent with depression and suicidal thoughts, if they go to the ER and are admitted, the closest place is in Valdosta,” he said. “They can’t use the same (crisis or inpatient) unit as adults.”
Pediatricians and family medicine doctors often have to fill the gaps in the weeks it takes to get an appointment at a child psychiatrist for treatment of a developmental and behavioral problem. Compounding the issue is that specialists either do not come to the area or do not stay.
“I can tell you the need has not been met,” Dyer said.
Schools have a difficult time managing the issue. Parents who are well-meaning may give their children a smartphone, thereby setting them up to become victims of cyberbullying. If there is not bullying going on, Facebook can be used as a means to brag — so restrictions and self-control is important.
Dyer said he would like to see schools involved more in individual planning with the proper level of staffing and adequate resources overall to ensure children can receive a definitive diagnosis and get effective treatment.
The steps parents can take depend on the age of the child and what they suspect. A toddler who is not talking could have problems ranging from language delay to autism. A child who is in school and hyperactive may not necessarily need medication, but an unbiased and early diagnosis is needed to determine the next step.
A teenager with depression, substance abuse and dealing with bullying will often give off non-verbal cues that something is wrong.
“If the thought crosses your mind that your child is depressed, don’t ignore it,” Dyer said. “Parents understand their children better than they are giving themselves credit for. Talk to someone about it.”
Dr. Nick Carden with the Renaissance Centre said his practice conducts assessments for children and adolescents with emotional, neurological and learning problems, while also giving guidance on how to manage depression, help with phobias and manage ADHD as well as assist with anger management.
In order to do this, the center works closely with pediatricians, family practice clinics, DFCS and foster agencies. It provides help to individuals, groups and families. The biggest caseload at the center is ADHD, followed by behavioral problems.
“We are beginning to see a number of kids who have had mood disorders of some sort,” he said.
Carden said bullying is a big contributor to mood disturbances. He said availability has increased for drugs and alcohol, so use of these substances are being seen at a younger age. Children are also showing up at youth detention centers at a younger age.
“If you don’t have a core family structure to keep you in the bonds of what is right and what is wrong, it is easy for kids to go wayward,” Carden said.
He said homegrowing a medical work force in southwest Georgia is critical to bringing in the staffing needed to handle the region’s pediatric mental health needs. The need is already significant, and it is not getting any lighter — and even those with insurance may have a hard time accessing services.
“There are more kids who are going to need mental health services,” Carden said. “They are not free, and insurance is slow to catch up that it is an important reimbursement.”
He said psychology and psychiatry services ought to be consolidated to increase accessibility, and that more resources should be put toward prevention. When suicide is a top cause of death in adolescents, and a lack of core family structure is turning children toward gang activity, it demonstrates that there is a need.
His practice’s approach is to see children on two- to four-week intervals, as weekly visits do not always offer enough time to change behaviors. Carden also advises parents not to immediately panic when they see a behavior that is unusual, but to track the behavior, how often it occurs and its intensity.
“When it gets to the point it is happening too often, or too long, give us a call,” he said. “When in doubt, err on the side of conservatism.”
A 20-hour course for the Georgia Youth in Crisis Training Program, primarily for law enforcement, educators, mental health providers, counselors, faith leaders, school personnel and other community members involved with youths is set for May 29-31 and June 19-21 at the Albany Police Department. For more information on the training and how to register, contact firstname.lastname@example.org.
Further information on youth-oriented programs through NAMI can be found at www.ok2talk.org, www.nami.org/sayitoutloud and www.nami.org/namioncampus. More information on NAMI Albany can be accessed by contacting (229) 329-1444 or emailing albanynami.org, and individuals can also email email@example.com or call the organization’s helpline at 800-950-NAMI.
For more information on the Commission on Children’s Mental Health, visit https://dbhdd.georgia.gov/commission-childrens-mental-health.